A strawberry by any other name would smell as sweet, green, fruity and buttery. Multisensory cognition of a food aroma.

This brief report presents illustrative findings from the first implementation for recognition of an aroma of individualised analysis of cognition as normed discriminations. Two assessors compared mixtures of four odorants with a fresh strawberry in overall aroma, its intensity and balance, and in the smell of each odorant conceptualised in their own words. By the second session, each assessor's judgments of overall likeness of a mixture to strawberry focused on one of the six mental processes tested. One assessor acquired a configural conceptualisation of all the odorants as smelling the same as strawberry. The other asssessor learnt to rate strawberriness by conceptualising the four odorants separately in judgments of both intensity and balance. Even this modest amount of data provides insights into mental mechanisms by which an individual perceives the complex profile of odorants released by a familiar material.

Daytime patterning of fatigue and its associations with the previous night's discomfort and poor sleep among women with primary Sjögren's syndrome or rheumatoid arthritis.

OBJECTIVES: Fatigue is a prominent symptom in many rheumatic diseases and has a substantial impact on many outcomes. In previous research, fatigue has been linked with poor sleep and discomfort, including joint pain and sicca symptoms. The aim of the present study was to investigate prospectively the daily variations in fatigue and the roles of discomfort and adequacy of sleep the previous night in that fatigue for people with primary Sjögren's syndrome (pSS) or rheumatoid arthritis (RA). METHODS: Thirty-nine women with pSS or RA reported their discomfort and fatigue for 35 days using the Profile of Fatigue and Discomfort. Sleep was monitored with wrist actigraphy, and the quantity and quality of the night's sleep was reported in a diary each morning. RESULTS: The pattern of fatigue did not differ significantly between women with pSS and women with RA. For participants with either condition, both somatic and mental fatigue increased steadily throughout the day. Multi-level regressions indicated that evenings of worse discomfort were followed by poorer reported quantity/quality of sleep and worse sleep efficiency (percentage of time asleep when in bed). In addition, a night of worse discomfort and poor sleep was followed by more severe fatigue compared with the individual's average. CONCLUSIONS: Fatigue management for people with rheumatic disease could include strategies for coping with discomfort at night and difficulties in sleeping. Further research into ameliorating fatigue should include assessments of persistent discomfort or periods of insomnia and identify disease-specific needs that require targeted intervention.

Predictors of fatigue over 1 year among people with rheumatoid arthritis.

Fatigue is a systemic feeling of exhaustion that is a common symptom of many chronic illnesses, including the autoimmune inflammatory disease rheumatoid arthritis (RA). We examined predictors of levels of fatigue among people with RA using Leventhal's Common-Sense Model (CSM), which states that cognitive representations of an illness spur (or halt) people's efforts to cope and thereby influence outcomes of the illness. Our use of the CSM was designed in the light of evidence in the literature specific to fatigue in RA. Current fatigue was reported on a 100 mm visual analogue scale (with anchors "No fatigue" and "Unbearable fatigue") by 114 people (73.7% women) with RA at baseline and 1 year later. Baseline employment status, pain, impact of disability, sleep disruption frequency, depressed mood, perceptions of consequences, arthritis self-efficacy and attempts to cope by praying/hoping were also self-reported. Duration of RA and a haematological measure of systemic inflammation (erythrocyte sedimentation rate; ESR) were obtained from hospital records. Unexpectedly, RA duration did not predict fatigue after 1 year, although lower baseline inflammation did (controlling for baseline fatigue and other disease impact variables). This may be due to sampling flares of RA at baseline. Baseline perceptions that RA has severe consequences and is uncontrollable also predicted greater fatigue after 1 year but this relationship was not mediated by praying/hoping. Targeted psychological care to modify perceptions of severe consequences may therefore improve later fatigue for people with RA even when the condition is longstanding, but the mechanisms of any benefit require further investigation.

Measuring fatigue among women with Sjögren's syndrome or rheumatoid arthritis: a comparison of the Profile of Fatigue (ProF) and the Multidimensional Fatigue Inventory (MFI).

BACKGROUND: Fatigue is common in both Sjögren's syndrome (SS) and rheumatoid arthritis (RA) and can restrict functioning. AIMS: We tested the convergent validity of the Profile of Fatigue (ProF) using the Multidimensional Fatigue Inventory (MFI) in SS and RA. METHODS: The 16-item ProF and the 20-item MFI were completed by 82 White-British women aged 35-79 years (mean 60.4 years). Thirty-four had been diagnosed with SS for a mean of 7.0 years and 48 had been diagnosed with RA for a mean of 14.5 years. The ProF measures four somatic facets of fatigue and two mental facets; the MFI contains one mental and four somatic facets. The structures of the items from both measures were tested by principal component factor analysis using varimax rotation. RESULTS: No significant differences in fatigue were found between the women with SS or RA. Five factors explained a total of 76% of the variance of the MFI; six factors explained 94% of the variance of the ProF. Mental fatigue items from both questionnaires loaded onto separate factors from somatic fatigue items; the two original facets of mental fatigue in the ProF were replicated. The four somatic fatigue facets of the ProF were generally replicated but the somatic facets of the MFI did not replicate as clearly. Equivalent facets correlated well between the two questionnaires (r >or= 0.65). CONCLUSIONS: Both the ProF and the MFI distinguish between somatic and mental fatigue in SS and RA but the ProF appears better at resolving somatic facets of fatigue.

Sleep disruption frequency in rheumatoid arthritis: perceived stress predicts poor outcome over one year.

BACKGROUND: Sleep is an important daily process that can be disrupted by chronic illnesses including rheumatoid arthritis (RA). AIMS: We tested whether demographic, medical and psychological factors act as predictors of change in frequency of sleep disruption associated with RA. METHODS: A cohort of 129 White British people with RA (mean duration of RA 7.19 years; mean age 55.40 years; 75% women) was followed for one year. Self-report questionnaires were employed to record demographic information and assess participants' sleep disruption (on a 4-point frequency scale), morning stiffness (duration), pain and fatigue (visual analogue scales), impact of disability, anxiety, depression, stress, coping, illness perceptions and self-efficacy. Hospital notes were reviewed for duration of RA, antidepressant use and comorbidity. RESULTS: Participants were split into those with sleep disruption that was consistently infrequent or decreasing in frequency (n = 56; 43%) and those with sleep disruption that was consistently frequent or increasing in frequency (n = 73; 57%). Results of a logistic regression demonstrated that greater perceived stress at baseline predicted sleep disruption that was consistently frequent or increasing in frequency over the year. Change in sleep disruption frequency was not predicted by any other assessed variable. Perceived stress at the end of the year was not predicted by change in frequency of sleep disruption. CONCLUSIONS: Self-reported frequency of sleep disruption among people with RA relates to perceived stress. Psychoeducational programmes that help people with RA manage their stress may be a non-pharmacological method of improving sleep quality and therefore merits testing in specific interventional studies.

Cardiovascular disease and psychological morbidity among rheumatoid arthritis patients.

OBJECTIVES: To examine whether patients with rheumatoid arthritis (RA) with co-morbid cardiovascular disease (CVD) have different psychological morbidity (and psychosocial risk factors for it) compared with RA patients without co-morbid CVD. METHODS: Patients with RA and co-morbid CVD (n = 44; hypertension alone for n = 27) were compared with RA patients without CVD (n = 110). Differences in psychological morbidity (depression and anxiety) and psychosocial risk factors for this (arthritis self-efficacy, acceptance, social support and optimism) were examined while controlling statistically for medical and demographic covariates. RESULTS: Groups did not differ on RA duration, RA activity, marital status or socioeconomic status, but RA patients with co-morbid CVD were older, less likely to be female and less likely to be in employment than those without CVD. RA patients with co-morbid CVD had significantly higher depression and were more likely to score above cut-offs for depression than RA patients without CVD. No differences existed in anxiety, although anxiety appeared to be more common than depression. Low optimism was identified as a possible psychosocial risk factor for depression. CONCLUSIONS: RA patients with co-morbid CVD have higher depression than RA patients without CVD; low optimism is a potentially modifiable risk factor that may mediate this difference. RA patients with co-morbid CVD may benefit from systematic screening for depression and targeted intervention if necessary.

Patterns of eating and movement that best maintain reduction in overweight.

Two studies of the influences of specific patterns of eating and exercising behaviour on body weight in English Midlands women were re-analysed using correlations as the measure of effect size. As predicted from computational modelling of hunger-sating mechanisms, avoiding energy-containing drinks and foods at the ends of and between meals was the behaviour most influencing year-long weight loss. However, although eating between meals is often called snacking, the term 'snack' appeared to be too ambiguous in this culture for its use in helping efforts to control weight. Avoidance of particular sorts of fat-rich foods was also associated with longer-term weight loss. Attempts at severe restriction of intake at mealtimes were associated with weight loss during a period of intensive dieting, but did not contribute to maintenance of that weight reduction. Using diet formulae to attain rapid weight loss was associated with significant weight gain over a year. These results support the suggestion that the first line of defence against weight gain is avoiding all sources of energy during drink breaks, with personally relevant advice on lower fat versions of particular foods also being important. Continued neglect of the behaviour-specific correlational approach to gaining evidence for less fattening habits does nothing to slow the rise in obesity.

Reactions to disability in patients with early versus established rheumatoid arthritis.

OBJECTIVES: This study examined differences in reactions to disability between early and established rheumatoid arthritis (RA) patients, and whether these reactions were related to age, physical functioning, acceptance of illness, or self-efficacy. METHODS: Thirty-four patients with early RA (< 2 years since diagnosis) and 84 patients with established RA (> 4 years since diagnosis) completed the Reactions to Impairment and Disability Inventory (RIDI), and measures of anxiety, depression, acceptance of illness, self-efficacy, and physical functioning. RESULTS: Early RA patients reported greater future denial than established RA patients. Younger patients reported more hostility than older patients. Accepting the illness was uniquely related to less anger and hostility. Higher self-efficacy for pain specifically related to greater shock, while patients with poorer self-efficacy for other symptoms reported worse anxiety, depression, shock, and anger. CONCLUSIONS: Denial may be a coping strategy in the early stages of RA: anxiety, depression, shock, and anger appear to persist. Longitudinal studies of RA patients from diagnosis are required to plan interventions timed to maximize patient benefit and optimize healthcare resource utilization.

Measurement of fatigue and discomfort in primary Sjogren's syndrome using a new questionnaire tool.

OBJECTIVE: Fatigue is a prominent symptom in primary Sjögren's syndrome (PSS). We set out to compare existing instruments and a new tool for measuring fatigue and general discomfort in PSS, with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and healthy controls. METHODS: Groups of female Caucasian PSS patients completed a new questionnaire developed from PSS patients' own vocabulary, as well as the SF-36, WHOQOL-BREF and HAD scales. For comparison, the questionnaire was also completed by groups of SLE and RA patients and healthy controls. RESULTS: Each disease group differed significantly from healthy controls on each facet of fatigue and general discomfort in the new tool. Somatic fatigue was worst in RA, while mental fatigue was worst in PSS and SLE. The facets of somatic fatigue and discomfort in the new tool correlated well with comparable domains in existing scales. CONCLUSIONS: Fatigue in PSS can be measured using this new Sjögren's-based psychometric instrument. The new questionnaire tool was more sensitive than the SF-36, WHOQOL-BREF and HAD at distinguishing the three rheumatic disorders from controls.

Perceptual channels for the texture of a food.

The present study makes a start on characterising the cognitive processes by which physical effects of eating on the senses are transformed into quantitative judgments about perceived characteristics of a food. It was hypothesised that there is a discrete perceptual channel for an aspect of texture sensed during each of the three initial movements of eating a piece of a cookie. The results showed that the force required for initial compression of the surface of the biscuit related to how 'crisp' it was. Scores on 'hard' were sensitive to higher forces being required to bite off a piece. Ratings of crunchiness responded to both amplitude and frequency of the cracks opened up in this heterogeneously structured material during the first crushing of the bitten piece. These findings are being pursued to identify the stimulation patterns more precisely and to measure how the percepts are integrated into judgments of overall texture.

Acquisition of texture-cued fasting-anticipatory meal-size change in rats with adequate energy intake.

To determine if an increase in intake at a meal before a long fast can be conditioned to food texture cues, male Sprague-Dawley rats were given a high- or low-fat diet in one texture (powder or pellet) for 1 h prior to a 12.5-h fast and in the other texture before a 3-h fast. Each group (N = 9) went through a pseudorandom sequence of four duplicates of each texture-fast pairing over 4 experimental days in each of three training trials, followed by one 4-day trial under extinction, i.e. without the difference in fast lengths between textures. Neither the high-fat group nor the low-fat group as a whole gave a clear indication of a learnt texture-cued increase in meal size before the longer fast relative to the shorter fast. However, the rats trained on the high-fat diet that had the highest intakes on the first 4 days of training showed a relative increase in the amount eaten of the texture predicting the longer fast during the third training trial, and this effect also approached statistical significance in the extinction test. These results provide some support for the conclusion that anticipatory hunger/satiety can be differentially conditioned to dietary texture cues, but only if sufficient food is eaten before a short fast to prevent the rise in hunger during longer fasts that reinforces the discriminative increase in meal size.

No unique role for nausea attributed to eating a food in the recalled acquisition of sensory aversion for that food.

Currently in the U.K., as in the U.S.A. 20 years ago, when students were asked to name a food that they did not like, more dislike for the food was attributed to nausea or vomiting after eating than to other gastrointestinal symptoms or to illness in other parts of the body. However, when members of the public first identified adverse symptoms and then attributed them to foods, and dislike for the food was first enquired about on a later occasion, there was no evidence for a unique role for a causal association with nausea in the human acquisition of food aversions. Furthermore, fear of the symptom was more prevalent than acquired sensory aversion when there was more precise recall of memories of the food being followed by nausea or vomiting and greater likelihood of there having been causal contingency rather than mere coincidence. Therefore, the more frequent invocation of nausea than of some other symptoms as the cause of a sensory aversion to a food may result from personal theory of the body, rather than from a veridically recalled occasion when nausea was contingent on eating the food---an event that must occur for aversion to arise from associative conditioning.

Sensory, digestive and metabolic influences on preference and intake.

In the 1960s. scientific work on the mechanisms of appetite began to shift from the effects of deprivation on reinforcement, motivation and sensation (hunger and thirst) to the influences of ingestion itself on what and how much was chosen at a bout of eating and drinking (the sating of appetite). This personal overview starts with John D. Davis's involvement in this trend to studying sensory, digestive and metabolic controls of meal volume, as he and the author each joined the field. The main topic is the diverse series of innovative experiments that Davis carried out in the author's research group in 1970 1971. This work exemplified Davis's technical inventiveness and theoretical precision. It generated influential findings on behavioural roles of dietary flavours, gastric distension and hepatic metabolism.

Food-conditioned odour rejection in the late stages of the meal, mediating learnt control of meal volume by aftereffects of food consumption.

In a two-bottle choice test, rats drank more of the fluid having a novel odour than that having an odour which had previously been presented in the later part of meals on concentrated maltodextrin solution. Rats are normally more averse to a novel odour than to a familiar odour; therefore, the conditioned reaction to the odour acquired in these circumstances is likely to be an ingestive aversion, rather than merely a lack of preference. Furthermore, this learnt odour rejection was seen only in the second half of the meal, indicating that it is dependent on an ingestion-induced state of repletion. Together then, these observations are evidence that the volume of meals rich in carbohydrate can be controlled by learnt rejection of particular food flavours in the presence of visceral cues specific to repletion (previously dubbed "conditioned satiety"), the only known mechanism by which aftereffects of ingested energy could reduce meal volume.

Macronutrient-specific dietary selection in rodents and its neural bases.

The only evidence for nutrient selection comes from baseline or treatment effects on nutrient intakes that are qualitatively similar when sensorily contrasting forms of each macronutrient are investigated and/or dietary compositions and strains of rat or mouse are different within or between laboratories. By that criterion the only potential case of a treatment reliably altering macronutrient selection identified in the present review of the literature is d-norfenfluramine, fluoxetine and paraventricular serotonin (5-HT) reducing the intake of dextrin-containing diets at early dark. The only clear example of reverse effects of an agonist and an antagonist on dietary intake was found with serotonergic agents. Claims for catecholaminergic or opioid involvement in protein intake and peptidergic involvement in carbohydrate intake were not substantiated. There remain the issues of which learnt macronutrient-specific postgastric actions and sensory cues from the affected diet rely on the neural pathway(s) on which the drug is acting to alter dietary selection. Until experiments address these questions, the neural bases of nutrient-specific appetites will remain unknown. Drug effects must be consistent across differently textured and flavoured versions of each macronutrient tested.

Evidence-based reduction of obesity: identification of a subculture's least fattening eating patterns.

Public health nutritional interventions, like clinical treatments in medicine or psychology, should be based on direct evidence of their efficacy relative to prior existing modalities. Yet the contribution of applied human nutrition and the psychology of eating to research into ways of slowing the rise of obesity has been limited to the intake of energy nutrients and investigator-prejudged questions about appetite and food choices. In contrast, it is feasible to get members of the public to describe their patterns of eating in their own words. Self-assessed current frequency of each common potentially less or more fattening eating pattern can then be used to associate weight change with changes in habit frequency. This design has been used to identify the long-term least fattening eating patterns retrospectively and prospectively in several studies in England and Germany. Without using assessments of usual nutrient intake, these studies demonstrate that the least fattening patterns over 1-2 or more years are drinks between meals with no energy intake, cutting back on fat in all foods and replacing as much sitting and riding as feasible each day with walking or cycling. An hypothesis to be tested by this method is that the only known automatic mechanism for eating less dessert is the learnt effect of boosting the readily digested carbohydrate content of high-energy main courses. Such evidence-based advice as well as self-therapy for emotional eating and body-shape distress should be the front line of defence against unhealthy weight gain and re-gain.

Psychological characteristics of people with perceived food intolerance in a community sample.

In most adults who believe themselves to be food intolerant there is no objective supporting evidence. It has therefore been proposed that the misperception of intolerance to food is linked to psychiatric illness or personality disorder. This hypothesis was tested in a community-derived sample of individuals who attributed an adverse symptom to a type of food. A random mailing recruited 955 participants aged > or =18 years, of whom 232 perceived themselves to be food intolerant (PFI). All recruits were sent two questionnaires, the General Health Questionnaire-28 (GHQ-28) and the shortened version of the Eysenck Personality Questionnaire (EPQ-R). A total of 535 GHQ-28 and 518 EPQ-R forms were returned that were correctly completed, an overall response rate of 55%. For the subscales of the EPQ-R, neuroticism was greater in those with a PFI than those without. Women with a PFI were more extroverted than control women. For the GHQ-28 subscales, women with a PFI had significantly higher scores than control women on somatic symptoms, anxiety, insomnia, and severe depression. There was a greater percentage of psychiatric caseness among women with a PFI than among men with a PFI or control women. Nevertheless, this percentage was no greater than that reported among a reference sample derived from NHS and university staff. It is concluded that perceived food intolerance is associated with psychological distress in women with a PFI, and neurotic symptoms in both men and women with a PFI, but there is no greater prevalence of psychiatric disorder among women or men with a PFI than there is in some professional groups.